Notice of Rescission

Affordable Care Act Notice Relating to Rescissions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2180 can be found here:

Documents and Forms

Document Name Document Type
TD 9491.pdf TD 9491 IC Document
TD 9744.pdf TD 9744 IC Document

Information Collection (IC) Details

IC Title:	Notice of Rescission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2712

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,533	733	800
Annual IC Time Burden (Hours)	20	-5	25
Annual IC Cost Burden (Dollars)	250	250	0

Documents for IC

Title	Document	Date Uploaded
TD 9491	TD 9491.pdf	05/12/2017
TD 9744	TD 9744.pdf	05/12/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.